The Aristocrats! Utah GOP manages to cover fewer people at a higher cost while crapping on the voters.

I wrote about this a week ago...

The full expansion initiative passed last fall, of course, is supposed to cover Utah residents earning up to 138% of the poverty line, or around 150,000 people...without any work requirements.

The bill barreling through the Utah Legislature was “an effort to override the will of the people,” said Matthew Slonaker, the executive director of the Utah Health Policy Project, a nonprofit group that supported the full expansion of Medicaid.

Utah lawmakers, worried that the sales tax increase might not fully cover the costs, are rushing through a bill that would limit the expansion of Medicaid to people with incomes less than or equal to the poverty level, about $12,140 for an individual.

State officials say that the bill, which is estimated to cover 90,000 people, could be on the desk of Gov. Gary R. Herbert, a Republican, in a week or two.

...not only would this bill overturn the explicit will of the voters and cover up to 60,000 fewer people, it would actually cost more then if they just expanded Medicaid directly, as the ballot proposal demanded:

In its place, the bill directs the state Medicaid agency to seek approval for an unusual and uncertain federal Medicaid waiver that would provide Medicaid coverage to 48,000 fewer Utahans and would cost the state $50 million more over the next two years, according to a state fiscal analysis.

(There's a couple of different estimates about the enrollment gap between the two expansion versions, ranging from 48,000 to 60,000...but it's definitely tens of thousands fewer people covered under the GOP bill).

Under CMS guidance, states can only receive the ACA’s enhanced federal match rate of 90 percent if they cover the entire expansion eligibility group. Therefore, Utah expects to initially receive its normal 68 percent federal match rate for its partial expansion, meaning it will have to cover 32 percent of the cost, instead of 10 percent under full expansion. Because it would cost more to pay for 32 percent of the cost of covering about 100,000 people than 10 percent of the cost of covering about 150,000 people, Utah would pay $50 million more to cover 48,000 fewer people through Medicaid, a fiscal note prepared for the Utah legislature confirms.


Well, sure enough, not only did they pull off this Trifecta of Asshattery, they did so in less than a week or fact, Utah Gov. Gary Herbert signed the bill just six days after last week's story ran.

Utah Gov. Gary Herbert on Monday signed legislation adopting a limited expansion of the state’s Medicaid program, defying voters who in November approved the full Obamacare program through the ballot.

Under the new GOP-written plan, Utah will ask the Trump administration for permission to implement unprecedented restrictions on the health coverage program for the poor, while insuring about 60,000 fewer people than the Obamacare expansion would have and initially costing the state tens of millions of dollars more.

However, there's an even more ironic twist here:

However, it’s still possible Utah could later fully expand Medicaid. If the Trump administration refuses the state’s plan, the legislation includes a trigger automatically adopting the Obamacare expansion while adding requirements for some enrollees to work or remain on workplace health insurance coverage if available.

Pointless, ineffective work requirements aside, as Nicholas Bagley notes it would be the height of irony if Utah Republicans ended up being forced to expand Medicaid to more people due to the Trump Administration (which, of course, hates poor people having healthcare coverage) refusing to let them expand it to fewer people.

Oh, to be a fly on the wall at CMS. A request for partial expansion from a red state puts them into a tough bind.

— Nicholas Bagley (@nicholas_bagley) February 12, 2019

Stay tuned...